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Published on: March 27, 2018
Trends in coronary artery bypass surgery: impact on early outcomes
Muhammad Musa Salick1, Irfan Qadir, Shazia Perveen
1Department of Cardiothoracic Surgery, Aga Khan University Hospital, Karachi, Pakistan.
Insights
Cardiac surgery patients are increasingly high-risk, yet operative mortality remains stable. This study analyzed trends in patient profiles and outcomes for coronary artery bypass grafting (CABG) over time.
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery Outcomes
- Coronary Artery Disease Management
Background:
- Nonsurgical revascularization advancements shift complex cases to surgery.
- Patients undergoing cardiac surgery present with later-stage coronary artery disease.
- Analysis of temporal changes in patient demographics and clinical profiles is crucial.
Purpose of the Study:
- To analyze temporal trends in demographic and clinical profiles of cardiac surgical patients.
- To evaluate changes in outcomes for patients undergoing myocardial revascularization.
- To identify factors influencing operative mortality over time.
Main Methods:
- Retrieved data for 3064 consecutive myocardial revascularization patients (2006-2011).
- Collected preoperative, intraoperative, and postoperative variables.
- Compared mortality and morbidity outcomes using univariate and multivariate analyses.
Main Results:
- Increasing mean age, left ventricular systolic dysfunction, unstable angina, and vessel occlusion.
- Declining prevalence of diabetes, chronic lung disease, prior stroke, and left main disease.
- Stable operative mortality (3.5% vs. 3.8%, p=0.512); key mortality factors include age, female sex, renal insufficiency, and longer bypass times.
Conclusions:
- Cardiac operations are increasingly performed on higher-risk patients with more comorbidities.
- Despite increased patient complexity, operative mortality has not significantly increased.
- This suggests improved surgical management and patient selection for coronary operations.
Background:
improvements in nonsurgical revascularization have left a group of higher-risk patients presenting for operation in a later stage of coronary artery disease. We undertook this study to analyze temporal changes in demographic and clinical profiles and outcomes of cardiac surgical patients.
Methods:
we identified and retrieved preoperative, intraoperative, and postoperative variables for 3064 consecutive patients who underwent myocardial revascularization at the Aga Khan University Hospital between 2006 and 2011. Mortality and morbidity outcomes were compared using univariate and multivariate analyses.
Results:
mean age, prevalence of left ventricular systolic dysfunction, unstable angina, mean number of occluded vessels, and arrhythmias at presentation increased steadily over time. The prevalence of diabetes, chronic lung disease, peripheral vascular disease, prior stroke, prior myocardial infarction, and left main disease declined. Operative mortality did not change significantly (3.5% vs. 3.8%, p = 0.512). Determinants of operative mortality included older age, female sex, renal insufficiency, left ventricular systolic dysfunction, and longer bypass and crossclamp times.
Conclusion:
coronary operations are increasingly performed in higher-risk patients with greater comorbidities. Despite this, operative mortality has not increased.
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